HOW BEST TO MEASURE IMPLEMENTATION OF SCHOOL-HEALTH CURRICULA - A COMPARISON OF 3 MEASURES

The impact of school health education programs is often attenuated by inadequate teacher implementation. Using data from a school-based nutr ition education program delivered in a sample of fifth graders, this s tudy examines the discriminant and predictive validity of three measur es of curriculum implementation: classroom observation of fidelity, an d two measures of completeness, teacher self-report questionnaire and post-implementation interview A fourth measure, obtained during teache r observations, that assessed student and teacher interaction and stud ent receptivity to the curriculum (labeled Rapport) was also obtained. Predictive validity was determined by examining the association of im plementation measures with three study outcomes; health knowledge, ask ing behaviors related to fruit and vegetables, and fruit and vegetable intake, assessed by 7-day diary. Of the 37 teachers observed, 21 were observed for two sessions and 16 were observed once. Implementation m easures were moderately correlated, an indication of discriminant vali dity. Predictive validity analyses indicated that the observed fidelit y, Rapport and interview measures were significantly correlated with p ost-test student knowledge, The association between health knowledge a nd observed fidelity (based on dual observation only), Rapport and int erview measures remained significant after adjustment for pre-test kno wledge values, None of the implementation variables were significantly associated with student fruit and vegetable intake or asking behavior s controlling for pre-test values. These results indicate that the tea cher self-report questionnaire was not a valid measure of implementati on completeness in this study. Post-implementation completeness interv iews and dual observations of fidelity and Rapport appear to be more v alid, and largely independent methods of implementation assessment.